| NPI | 1760880603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IL 038-004048) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IN 08000688A) |
| Enumeration Date | 2014-12-09 |
| Last Update Date | 2014-12-09 |